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The impact of noninvasive versus invasive mechanical ventilatory support on survival in hematological patients with acute respiratory failure

Objective

To assess the impact on ICU survival of noninvasive (NIPPV) versus invasive mechanical ventilation (IPPV) as the initial ventilatory mode in hematological patients with acute respiratory failure.

Design

A retrospective evaluation of a prospectively followed cohort of 277 hematological patients ventilated at the ICU of a tertiary care hospital between January 1997 and June 2006.

Results

NIPPV was the initial ventilatory mode in 56 patients. ICU mortality in patients with initial NIPPV versus IPPV was 62.9% and 62.5%, respectively (P = 0.99), but SAPS II at ICU admission was lower in NIPPV patients (45 ± 15 vs 60 ± 18, P < 0.001). NIPPV was the sole mode of ventilation in 15 patients and was followed by IPPV in 41 patients (NIPPV-IPPV). ICU mortality in sole NIPPV patients was 35% compared with 76% in NIPPV-IPPV patients. In a multivariable analysis, the ICU mortality of ventilated patients was associated with SAPS II at admission (OR 1.029, CI 1.009–1.048, P = 0.003), NIPPV-IPPV (OR 2.73, CI 1.1–6.8, P = 0.03), and bacterial infection (OR 0.39; CI 0.21–0.73, P = 0.003). The mean change of SOFA between day 1 and day 5 was 0 (± 2.6) in NIPPV patients (n = 33) compared with -1.6 (± 4.3) in IPPV patients (n = 87) (P = 0.001) surviving beyond 5 days of ICU admission (Figure 1).

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Figure 1

Conclusion

NIPPV was not associated with better outcome in our population of hematological patients with acute respiratory failure. NIPPV followed by IPPV was an independent predictor of mortality.

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Depuydt, P., Benoit, D., Roosens, C. et al. The impact of noninvasive versus invasive mechanical ventilatory support on survival in hematological patients with acute respiratory failure. Crit Care 11, P167 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5327

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Keywords

  • Mechanical Ventilation
  • Bacterial Infection
  • Respiratory Failure
  • Tertiary Care
  • Multivariable Analysis